Provider Demographics
NPI:1750124541
Name:UTAH SPINAL WORKS
Entity type:Organization
Organization Name:UTAH SPINAL WORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-770-4333
Mailing Address - Street 1:5455 W 11000 N STE 107
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-8801
Mailing Address - Country:US
Mailing Address - Phone:801-770-4333
Mailing Address - Fax:
Practice Address - Street 1:5455 W 11000 N STE 107
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8801
Practice Address - Country:US
Practice Address - Phone:801-770-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty